Loading...
Permit A � n CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00454 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/5/2007 PARCEL: 2S103CB -02400 SITE ADDRESS: 13205 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: WILLAMETTE LOT: 004 JURISDICTION: TIG PROJECT: WALL Project Description: Line work to connect sewer to lateral. Septic system to be pumped and filled or removed. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 80 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KENT WALL 13205 SW 121ST. AVE Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 10/5/2007 $72.50 [TAX] 8% State Surcha 10/5/2007 $5.80 Phone : 503 -579 -6466 Total $78.30 Contractor: A AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 969 -9548 FAX 503 -570 -0779 Reg #: LIC 158246 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. / Issued By 4 L Permittee Signature: , / Atiodi • Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. , e, Plumbing Permit App Em im .. om ,: Building Fixtures (� f FOR OFFICE' USE ONLY ' CC 1 0 5 2007 Received - City of Tigard Date /By: /(7 • • p 1 A 54 V Permit N ►. �7�o C �L5L / I 13125 SW Hall Blvd., Tigard, � g w � .� n r . �, Plan Review ' Phone: 503.639.4171 Fax: 595 98.160 t� : Other Permit 1S� �/Jinp)a56 Plan Re T 1 G A R D Inspection Line: 503.639. f DING DI t I S g g ', to Ready/By: (1,11.- VI Page 2 for Internet: www.tigazd -or.g lJ i.�J 1 �� j i Notified/Method: Supplemental Information • TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 1=1 Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION. Site utilities Job site address: (, 3 2 05 S k., L )_ L s T i\. t/ e. • Catch basin or area drain 16.60 City /State /ZIP: �) a„) j } O (. , C, .7 2 -2.. 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft. Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 ' DESCRIPTION OF WORK Backflow preventer Page 2 • COAX-X.1 66 ! e_ - _ _ (4)641 Backwater valve 16.60 . • Y / /v �� ll// e-,04.-44...e 0-1 t.0 {„41 � ... /J Clothes washer 16.60 v � ^;�// Dishwasher 16.60 N<PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: --- /v1' lyki A L /� Expansion tank 16.60 . Address: 13 Z O s S W `Z c - ( - A.,) a Fixture /sewer cap 16.60 City /State /ZIP: r ( , 1 4,0/.., q ZZ - Floor drain/floor sink/hub 16.60 ( c 3 S7 cz , ci), `i 6O Garbage disposal 16.60 Phone: Q L Fax: ( ) ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR W ater closet 16.60 Business name: A. , , 4 j 1 _ 4 j LE. Water heater 16.60 Address: O e,f5, % 1 30 .be- Other: 90 ^ t X City /State /ZIP: u - c ), D ,,� J ,�` � © 2 ' 5 -7 D Subtota "'� Minimum permit fee: $72.50 ,7A.. j Phone: (6{ 9 l0°1 ,c 5 V Fax: ( ) Residential backflow minimum permit fee: $36.25 ll ( 1 �15 aq b Plan review (25% of permit fee) CCB Lic.: Plumbing Lie. no.: - State surcharge (8% of permit fee) LT g(2 • uthorized si•_ ature: i % i 1 1 TOTAL PERMIT FEE �g 3 /) AY`��� Cdr/ Date: This permit application expires if a permit is not obtained within - - 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I1 Building \Permits\PLMF - PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) A 835 Bt`s Plumbing Permit Application - City of Tigard' Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: . Site.U tie - x Qty: Fee (ea) Total Square' Footage: Permit Fee: Footing drain - ls` 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuati' on: Permit Fee:. Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each ''Fixture or Item Qty. . Fee•(ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00 Rain Drain, single family dwelling 65.25 "$25,001.00 to $50,000.00 $379.50 the first $25;000:00 and $1.45 for each additional $100.00, or fraction thereof, to Inspection of existing plumbing or - specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Plumbing, Installation s Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑Y new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added _ Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918 780 - 0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as /defined in OAR918 -780 -0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any'of the above. Dishwasher - Commercial . - Domestic Drinking Fountain Isometric or Riser Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" - 4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory • .. • - Bradley *Note: If the fixture work under this permit results in an - Commercial _ increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: • is \ Building \Permits\PLM- PermitApp.doc 12/27/06 wimmiimmiwiliwwwwwww .4, .,.,...... :: ,,.,, z: P..: .-, *RDA ILE ...;., I SEPTIC SERVICE - P.O.BU)C 1130 =" WILSONVILLE, OR 97070 1 r1 (503) - :z : :;.2 9929 FAX (O3) S7G.O779 CUSTOMER'S ORDER NO. PHONE DATE / 3 41/ / Z / c.> 7 NAME 1C e m 4- ( A-11 . ADDRESS • SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT _ Q TY.`' _ DESCRIPTION _ IPTION PRICE AMOUNT 4 = Oompea .s-e , C. a ^ • Q.:„.? V X eio /' t A-,, r o 4/ , i � ( ff / 17/1 .1 , a F ` / ; J� I (/ i / . ,. 1 g `.i V ye I- i TAX RECEIVED BY TOTAL � All claims and returned goods MUST be accompanied by this bill., /Agelg/ To Reordan THANK YOU 800-22 ca ntbs.c CITY OF TIGARD BUILDING DIVISION f PERMIT #: PLM2007 -01464 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: -- 10/6.r2007 Phone: (503) 639 -4171 tliP$0 Inspection Requests (24 Hrs.): (503) 639 -4175 J -''.L. INSPECTION WORKSHEET FOR DATE: 10/12/2007 TIME: 7 PAGE: 17 SITE ADDRESS: 13205 SW 121ST AVE CLASS OF WORK: SUBDIVISION: WWLLAMVME I i E LOT #: 00M TYPE OF USE: PROJECT NAME: WALL DESCRIPTION: Line work to connect sewer to lateral. Septic system to be pumped and filled or removed. OWNER: WALL, KENT PHONE #: 503 - 579.6450 CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: r;Q3.969 -9548 Inspection Request Scheduled For: Date: 10/12/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 606 Sanitary ewer 057640-01 503 - 969.9548 Y Corrections /Comments /Instructions: _c -k c.. 1 1-- ICI k „.., Put- . -- -cAt c,A re_ ci P.,4-e4 94,-) PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 4`�' A '"` Date: 1 O 11240'7 Phone #: (503) 718-